For this week's excerpt, I'm sharing part of an early chapter of Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety. Alcoholics drink that first drink for many of the same reasons non-alcoholics do: among the reasons is to relieve stress. Non-alcoholics can stop, alcoholics cannot, after the first drink. Chapter Two covers stress and cortisol and their relation to relapse, plus the new research revealing how the stress hormone alters the perception of and reaction to stress in those with the disease of alcoholism.
"The stressors Alcoholics pile up over periods of sobriety aren’t the small day-by-day stressors like coffee spills on new carpet. They’re the four major category stressors covered in chapters four through seven. The longer you spend in prolonged stress with the cortisol rioting through you, the more intense your feelings of helplessness and, sometimes, emotional numbness. You at times feel like you’re just going through the motions. Things “normal” people drink to forget.
Adrenals,
like the rest of the body, are not designed for prolonged stress
according to Dr. Aphrodite Matsakis (I
Can’t Get Over It,
New Harbinger Publications, Oakland, CA 1992). “The adrenals can be
permanently damaged leading to overfunctioning during subsequent
stress. If you were subjected to repeated or intense trauma or
stress, certain biochemicals may have been depleted.”
In
a famous series of experiments conducted by Martin Seligman in the
1970s, animals were subjected to electrical shocks they could not
flee no matter what they did or did not do (Helplessness:
On Depression, Development and Death,
W.H. Freeman, San Francisco, CA 1975). They fought at first. Later
the animals became listless when shocked. This was phase one. In
Seligman’s second phase, the animals were shocked again but could
prevent the zap by pressing a button. They didn’t. They were too
changed biochemically to take a simple
action to end their suffering. Bessel van der Kolk (in Journal
of Traumatic Stress, Vol.
1, 1988) followed up the Seligman work and concluded the shocked
creatures had the same biochemical imbalances as humans enduring
prolonged exposure to stressors. With people though, human nature
dictates that we try to avoid or escape anything to do with the
stressor. Someone might, for example, avoid driving a car after the
stress of a car wreck. That is a single, short-duration stressor. An
Alcoholic, like Seligman’s experiment subjects, has multiple
stressors of long duration. And you can’t run from them all. Like
the two experiments convincingly demonstrated, there’s a point at
which we don’t even save ourselves. Alcohol
becomes an efficient escape.
Initially
as we begin abstinence, we’re told to save ourselves from triggers.
People. Places. Things. And the things in slogan-happy and
acronym-rich rehab we call HALT: being Hungry, Angry, Lonely or
Tired. Research demonstrates that those triggers lead to lapse
because you are not thinking your clearest thoughts. When your
stomach growls the oldest parts of the brain focus your body’s
resources on food. If you’re focused on food, you’re not focused
on sobriety, the thinking goes. You’re juggling sobriety’s apples
and hunger throws you a chainsaw. When you’re tired, your thinking
is blunted by your need for sleep. When you’re angry or lonely, you
may prioritize resolving those emotions rather than concentrating on
sobriety. HALT is a good starting point. The objective is to stay out
of harm’s way. Avoid. But the four
major stressors knocking
our cortisol out of whack and leading to lapse, you cannot avoid. We
need to instead alter our reactions to them.”
The first drink is the ESC key for the big stressors in the book, even for infrequent drinkers. Alcohol has managed to remain popular for millennia for that reason despite troubling social or physical outcomes from alcohol misuse. For non-alcoholics, stopping after that first drink, after hitting the ESC key, isn't an issue. All bets are off for the Alcoholic after the first drink to break the stress. That isn't to say violence or illness is inevitable for that episode, just that stopping at one is not an option. Many drinkers have tried and failed that simple test. After the first one, it's like trying to slam a revolving door.www.alcohologist.com
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